James Gleick, the greatest science journalist of our time, reviews Lee Smolin’s book on time. Gleick says, “Smolin’s argument develops slowly and builds suspense. The reader starts to wonder whether the lady being sawed into pieces will come out of the box alive.”
Smolin, apparently, has thrown away the standard idea that time is just another fourth dimension. He has brought back to life the intuitive idea, long rejected by scientists, that the past is gone and the future is uncertain. As Gleick explains:
“Past things were real once but have ceased to exist. Future things don’t yet exist; they will become real only when the time comes.
This is the view that most physicists deny and the view that Smolin proposes to demonstrate in his book.”
With the release of DSM V, a controversy has erupted about the Diagnostic and Statistical Manual, the catalog of psychiatric disorders. Critics have railed against it for years but until recently have been dismissed as outsiders. Now the dam has burst and it has gone mainstream. Here is a roundup of news and commentary on the issue from the past two weeks.
Thomas Insel, Director of the National Institute of Mental Health (NIMH), which is the biggest funding body for mental health research, announced that “NIMH will be re-orienting its research away from DSM categories.” The reason was that
…it is critical to realize that we cannot succeed if we use DSM categories as the “gold standard.”2 The diagnostic system has to be based on the emerging research data, not on the current symptom-based categories. Imagine deciding that EKGs were not useful because many patients with chest pain did not have EKG changes. That is what we have been doing for decades when we reject a biomarker because it does not detect a DSM category. We need to begin collecting the genetic, imaging, physiologic, and cognitive data to see how all the data – not just the symptoms – cluster and how these clusters relate to treatment response.
Instead, Insel explains, the NIMH is developing a new system, one based on genetics, cognitive science and biological markers called Research Domain Criteria (RDoC).
Insel’s announcement was widely reported. For example, the New Yorker: The Rats of N.I.M.H.: Posted by Gary Greenberg
When Thomas Insel, the director of the National Institute of Mental Health, came out swinging with his critiques of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, a couple of weeks ago, longtime critics of psychiatry were shocked and gratified. Insel announced that that the D.S.M.’s diagnostic categories lacked validity, that they were not “based on any objective measures,” and that, “unlike our definitions of ischemic heart disease, lymphoma or AIDS,” which are grounded in biology, they were nothing more than constructs put together by committees of experts. America’s psychiatrist-in-chief seemed to be reiterating what many had been saying all along: that psychiatry was a pseudoscience, unworthy of inclusion in the medical kingdom.
Carol Tavris in the WSJ: How Psychiatry Went Crazy: The “bible” of psychiatric diagnosis shapes—and deforms—both treatment and policy.
… the DSM grows by leaps and bounds with every revision. The first edition, published by the American Psychiatric Association in 1952, was a spiral-bound pamphlet that described 11 categories of mental disorder, including brain syndromes, personality problems and psychotic disorders. (The final category, “Nondiagnostic Terms for the Hospital Record,” contained Dead on Admission, the one diagnosis that psychiatrists have ever agreed on.) The DSM-II (1968) made homosexuality a mental disorder, a decision revoked by vote in 1973. In the general excitement about that progressive decision, few noted that voting didn’t seem to be the most scientific way of determining mental illness. Narcissistic Personality Disorder was voted out in 1968 and voted back in 1980; where did it go for 12 years? Doctors don’t vote on whether pneumonia is a disease.
It seems like a violation of the empirical principles of science on which medicine was founded. And yet, incredibly, doctors were perfectly content to accept a vote on these issues. In this article Tavris gives a history of opposition to the DSM and also discusses prominent books by Greensberg and Francis.
Also in the WSJ, Paul McHugh: DSM-5: A Manual Run Amok. It’s time for psychiatry to drop its field guide and try to learn about mental ills
Today the public complains that psychiatrists seem ready to call every state of mental distress an illness. They see that any restless boy can receive a diagnosis of attention deficit disorder, that troubled veterans—whether exposed to combat or not—are routinely said to suffer from post-traumatic stress disorder, and that enormous numbers of discouraged, demoralized people are labeled victims of depression and have medications pressed upon them.
The public is not far wrong. A recent nationwide diagnostic census based on DSM claimed that the majority of Americans have or have had a mental disorder.
That is probably the most pernicious effect of the failings of the DSM: pretending that normal human experience is a medical condition. Not only does this dilute the attention given to the truly mentally ill, it confuses the public and results in large numbers of people taking medications that they do not need.
Dr Allen Francis, who led the team who rewrote diagnoses for the DSM IV in 1994, was interviewed this week on ABC Lateline. Francis is critical of the DSM because of the widespread misuse among primary care physicians (known in Australia as “general practitioners,” GPs). But he thinks the basic idea is sound, it has been misused.
EMMA ALBERICI: Tell us, what were the mistakes that you say you made in hindsight in leading this team that developed the DSM IV?
ALLEN FRANCES: We were very worried about diagnostic inflation in psychiatry and excessive treatment. So we were quite conservative in our efforts and accepted only two of 94 changes. But our conservatism was absolutely overwhelmed by drug company marketing. And despite our best intentions, there have been three epidemics: attention deficit disorder, autism and bipolar disorder. If I had it to do over again, we would have been even more conservative, more restrictive and we would’ve put lots of warnings in most of the diagnoses that were being overdone. That might not have worked, but we should’ve tried harder.
EMMA ALBERICI: So how much influence do you say big pharmaceutical companies exercise in the drafting of these DSM – what is now DSM V?
ALLEN FRANCES: They’ve absolutely no influence at all in the drafting, but they wait on the sidelines, eagerly awaiting the new manual because it will allow them marketing opportunities that will result in billions of dollars of extra revenue.
Frances has a lot of wisdom and insight into the DSM and its problems. However he is too willing to forgive doctors as naive dupes of the drug companies; but as physicians, their responsibility is total. If they overprescribe or misdiagnose, it is their decision to do so, whether or not Big Pharma has been bombarding them with advertising. Doctors are the ones who give diagnoses; to ignore their willing over-use of the DSM is to ignore an important part of the problem.
From the NYT, a new finding about salt.
In a report that undercuts years of public health warnings, a prestigious group convened by the government says there is no good reason based on health outcomes for many Americans to drive their sodium consumption down to the very low levels recommended in national dietary guidelines.
We’ve seen evidence about salt’s benign role before.
Does this mean we should cut loose and salt it up?
There’s no evidence to suggest otherwise. The rational thing to do – based on empirical evidence – is to make no change to your salt intake. There’s no evidence that it’s bad for you. None at all.
Salt is an ancient and versatile flavor enhancer. It makes food taste good, and we now know that it has no measurable detrimental effect on your health. Plus it’s vital to your body’s function. Salt deficiency is a known and serious problem. So let’s quit the crusade against this necessary and delicious flavor and get back to enjoying our food.
Don’t take my word for it. Salt denialists are not hard to find.
Mandelbrot was an intellectual outsider, an independent thinker who found no solace in the halls of academia. ““I saw no compatibility between a university position in France and my still-burning wild ambition,” he wrote. He left the crusty halls of French universities to America, where he got a job at IBM. With access to their powerful and state-of-the-art mainframes, he developed his now famous work on fractals.
One application of fractals was to financial markets; but while Mandelbrot sets have become a household name, their use in finance has never caught on. His marginalisation by economics caused him great resentment.
The fractal model of financial markets that Mandelbrot went on to develop has never caught on with finance professors, who still by and large cling to the efficient market hypothesis. If Mandelbrot’s analysis is right, reliance on orthodox models is dangerous. And so it has proved, on more than one occasion. In the summer of 1998, for example, Long-Term Capital Management—a hedge fund founded by two economists who had won Nobel Prizes for their work in portfolio theory and staffed with twenty-five Ph.D.s—blew up and nearly took down the world’s banking system when an unforeseen Russian financial crisis foiled its models.
But what would a fractal based financial model look like? Is the reticence due to inertia and resistance to a paradigm shift? Or are fractals simply too complicated to be of practical use in a large scale modeling environment like finance? A Mandelbrotian financial model would have to have superior predictive power across a wide range of situations; the observation that financial patterns are fractal in nature might not be enough to generate the powerful modelling that’s needed.
Outsiders play an important role in intellectual discourse as they can often lead to surprising insights and new ways of looking at phenomena. however they are prey to the Maverick’s Fallacy which is that “all resistance to the Maverick’s ideas is due to their ‘outsider’ or ‘maverick’ status.”
Sometimes that’s the cause of resistance; sometimes it’s not.